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How long to switch to the breast??

OK, so I'm new here. I've been reading all of the bf-ing your preemie posts to try to find some encouragement and answers to my questions before posting, but I'm still needing some more info. Everyone's posts have been super helpful, though! So thanks for sharing all of your experiences with other mommys

My son was born in December at 28 weeks, and just came home last week. Today is actually his due date, so he is just now "full term." In the NICU, I was putting him to breast about once a day when I could be there, and sometimes gave him a bottle after depending on how much he took (weighed before and after feeding to determine how many cc's he got). He's always been on EBM, so all bottles are my milk. Now that we've been home, I've been putting him to breast at every feeding, then offering him a bottle after. Most of the time he takes some, but sometimes he doesn't. He gets really sleepy at the end of breastfeeding and then wakes up a little when we give him the bottle, then gets sleepy again.

So, I have a few questions, I guess...

* If he's getting so sleepy, how do I know if he's taking enough? (He wets lots of diapers, but poops rarely...)
* Should I be putting him to breast every time? Or, should I do some straight bottle-feeds to avoid making him too tired?
* How can you tell if he gets to a point where he is just using my nipple as a pacifier?
* How long did it take you moms to switch to JUST the breast where your LO was taking enough and you didn't have to supplement with a bottle?

I am using a nipple shield, because I have a forceful let down, and he fusses a lot and/or refuses my breast when I don't have the shield. His mouth is also very small. He does latch and suck/swallow for a while on the shield.

I'm just getting scared that I will never be able to get him off the bottles, and I don't know how much I need to "push" it. I don't want to tire him, but I don't want him to be on bottles forever, because I just HATE pumping! YIKES!

Re: How long to switch to the breast??

Originally Posted by @llli*tinabobena83

* If he's getting so sleepy, how do I know if he's taking enough? (He wets lots of diapers, but poops rarely...)
* Should I be putting him to breast every time? Or, should I do some straight bottle-feeds to avoid making him too tired?
* How can you tell if he gets to a point where he is just using my nipple as a pacifier?
* How long did it take you moms to switch to JUST the breast where your LO was taking enough and you didn't have to supplement with a bottle?

Congratulations on your early arrival and your commitment and success so far with breastfeeding! I'm so glad your little one is home with you now.

Output and weight gain are really better indicators of sufficient intake than pure volume. How rare is rare for a poop? Plenty of wet diapers is an excellent indicator that he is getting enough, as frequency of bowel movements has quite a large normal range.

Personally, I would put him to the breast every single time, and as often as possible. In fact, I would wear him skin to skin and encourage nursing as frequently as he is willing and able to do so.

Nipples are the original pacifiers. No pacifier could be better for your little one at this point than you breast.

Hang in there, and seriously -- skin to skin, breastfeeding as often as he shows the slightest interest -- that was the best advice I ever got....

Re: How long to switch to the breast??

Another congrats on having your baby at home in your arms. My oldest is a NICU grad and I so hear you on the pumping. I really disliked it and was so grateful when it wasn't necessary anymore. Nice job on keeping with the breastfeeding and pumping, though - mamamilk is invaluable to the really little ones.

Lorenzomama gave you good advice on keeping him skin to skin as much as you can and letting him nurse whenever he shows interest. Have you looked into using a stretchy wrap to keep him nestled against your chest? The MobywrapD was a lifesaver for me to do kangaroo care at home and not be limited to sitting down - I was able to just wrap my son onto my bare chest, (put on unbuttoned cardigan or shirt over the top if your arms are cold) and the closeness really helped my son not only sleep but be able to show interest in nursing more frequently. The frequent feeds will help him stay full (and help your supply stay up as you taper down - hopefully - on the pumping) without you needing to offer the bottle after every feed.

That said, your ped will, I'm sure, be keeping an eye on growth and output (how frequently is he pooping?). As long as that's ok, just keep putting him to the breast as often as he is interested - especially these next couple months.

Re: How long to switch to the breast??

Good morning! Thanks to you ladies for your advice! I did just get a Moby wrap from a friend to borrow, and am washing it right now. I'll be trying that out later today

To answer some of your questions - I have seen a lactation consultant...they had a great one at the hospital where I delivered and where my boy was in the NICU. I can't go back now that he's discharged, because my insurance doesn't cover it, but we did become good friends and she said I can call any time. So, I have been doing that...

About the peeing/pooping...he wets every diaper, and I change him about 9 times a day. He poops maybe every other day. I did call the ped on that, and he said to just wait and see. I have a home visit weight check this evening, so I am anxious to see if he has gained any weight since last Friday (or enough weight, rather). If not, we'll be calling the ped again.

Some good news, though, is that twice in the past day, my little guy has seemed satisfied with the breast, and when I pumped the side he was nursing from, it was either empty or nearly empty (like less than 10 ml left). So that was very exciting for us! I'll let you know about the weight gain.

Re: How long to switch to the breast??

That's great that he's draining the breast! You're doing a great job!

I hope the weight check goes well and you get some good reassurance from the visiting nurse. And that's great that you were able to borrow a moby wrap...if you have any questions on how to use it, there are youtube videos available as well as good directions on their website. Or ask here!

My DS also pooped infrequently - it became increasingly infrequent and wasn't a problem until he was older. As a young infant, his ped said that one poop up to every 14 days for an EBF baby is within the realm of ok. That may not be the case for your little one - definitely go by what your ped says and advises, but I just wanted to add our experience in there. Premies sometimes have gut motility issues (mine did as an older baby/toddler once we started solids) but since breastmilk is so digestible, it's more common that less comes out simply because it is all being utilized. 9 wet dipes a day is a good sign, though.

Re: How long to switch to the breast??

I am just throwing this out there regarding the sleepy baby thing. My son was born 7 weeks early. He started out with no oxygen, just fine, but they had to move him to gavage feeding with oxygen because of how tired he would get and his desats. Everytime they tried to take him off the oxygen, he would desat at feedings. They finally did some tests (I don't know why they didn't do them sooner) and found out that his iron was low. Makes perfect sense to me. After we started iron supplements, the oxygen was no longer needed and he was much more vigorous at the breast, and even when not feeding. If you haven't looked into it, maybe you should ask about getting his iron checked and/or give him supplements.

Re: How long to switch to the breast??

Congrats on your little one! It sounds like you guys are doing great with breastfeeding!

As far as how long it took to switch to breast without any bottle supplementation - for us it was about 2 months after my son came home from the NICU. My son was born at 29.6wks and was in the NICU for almost 2 months. I was only able to latch him on a few times while he was there and only once was a "full feeding" meaning they didn't gavage/bottle feed him after he breastfed.

One thing I did (because I had resistance from his pediatrician's in switching off bottles) is I rented a baby scale from a local pharmacy (I think you can buy them at Target now) and weighed him before and after feedings as well as once each night and I kept track of everything. I wrote down all his diapers. And then when we went in for weight checks/appointments I would show the pediatricians and everyone started to relax over time as he was gaining weight great.

As far as how often you should be putting him to breast vs. doing some straight bottle feeds - I would see how his weight is every few days maybe to see if he's gaining enough. Because with these little ones they really can tire out easily and so it's a little tricky. How did the weight check go for you the other day?

Also, wearing my son in a Moby Wrap was awesome, I'm so glad you have one that's great for you and your little one. I think it really helped my son with breastfeeding because he was so close to me, skin to skin, so it helped us bond and helped me know when he was showing hunger signs since he was so close.

Let us know how it's going!

Mommy to:

Emmalynn Marie
Born at 37 weeks on 12/22/06
5lbs 1oz 19 1/2in

Owen Charles
Born at 29 wks 6 days on 01/17/09
2lbs 14oz 15in
In NICU for 2 months

Re: How long to switch to the breast??

I agree with everything the PP have said, however the key is going to be weight gain. If he is still losing or not gaining at a strong enough rate then the calories that he burns "trying" the breast could be more detrimental. Which is very often why hospitals don't allow you to try until they are a certain age. You don't want him to be working so hard and not replenishing that with milk from your breast. Just something to think about.

For my daughter it took 3 months - 2 months after leaving the NICU - until she was nursing regularly with no bottles.

Re: How long to switch to the breast??

Hi, ladies! Thanks for all of your helpful info. Here's an update on my situation...

Our weight check last week revealed no weight gain after one week home from the hospital My little guy was having some serious reflux issues, and was spitting up what seemed like everything he was eating, so we suspected that the lack of weight gain was due at least in part to the reflux. So, we went to the DR on Friday, and were prescribed Axid. When at the DR, I asked about bf-ing and supplementing, and he suggested I just try to exclusively nurse my son until today (Wednesday) when he would see us back to see if there was any weight difference. So, We did it! I just nursed him at every feeding, and trusted that he was getting enough. His wets and poops were all good, so we know he was getting enough, even though he wasn't nursing for a terribly long time - only about 7-10 minutes and only on one side.

Today, though, we went back to the DR for our check, and my son has not gained any weight. He has been at the same weight since his discharge from the NICU on March 9. . The poor guy just can't gain anything! So, DR wanted me to give him formula exclusively to pack on the pounds. I freaked out. We finally settled on HFM, which was what DS was on in the NICU, so I'm OK with it, and DR seemed very happy with that, as he would know from a medical standpoint that DS is getting 24 calorie or higher. Hopefully next Wednesday will bring some extra ounces with it!!

So, all that to say, we were nursing well, but now I'm exclusively pumping again. Hopefully soon we can try the breast again. I think I will still nurse him once a day...just so I can have my time with him that I miss already just thinking about it!